~~Continuous Improvement
Unnecessary Transport
“Nothing is less productive than to make more efficient what should not be done at all.”
- Peter Drucker
“Progress isn't made by early risers. It's made by lazy men trying to find easier ways to do something.”
- Robert A. Heinlein
“Well, here's another nice mess you've gotten me into!”
- Oliver Hardy, Sons of the Desert 1933
Just another reminder, in January’s blog, waste was defined as, “anything beyond the absolute minimum amount of materials, manpower, or machinery needed to add value to a product or service”. (Flinchbaugh & Carlino, 2006) As I mentioned in that blog, there are seven main sources of waste in the dental practice:
• Overproduction
• Waiting
• Unnecessary Transport
• Over-processing
• Excess Inventory
• Unnecessary Motion
• Defects
In April’s blog, we discussed Waiting and its possible application and impact on the dental practice
This month, we’ll talk about Unnecessary Transport. In Lean parlance, Transportation is defined as: “Any movement of material, paper, or information including shipping, moving, carrying, or even lifting.” (Flinchbaugh & Carlino, 2006)
Drucker’s thought is the first one we ought to address in this context. We often seek to make more efficient what should not be done at all. Ask yourself, “Are we moving things around that shouldn’t be there in the first place?”
Humans tend to hold on to, not just material things, but also: policies, procedures, ideas, etc. that have been around for a long time without being examined and dealt with. How many times have you walked around something and thought, “I’ve got to move that – when I have time.”? Or, “There must be a better way to do this!”? Do you have a list of ‘To Do’s’ that you never get around to? It’s time to deal with things that should not be done, and find a better way to do what must be done! And, as Heinlein said, you’ll only be making things easier on yourself by doing this.
An important concept in Lean thinking is that moving even one inch is a ‘transport’. If you get rid of those inches, you can shorten your transport, eventually, by miles over time. Let’s look at a few examples:
• Can a source be moved closer to the destination?
o How far do you have to walk to
Take an x-ray?
• Get the film or sensor
• Get the cover for the film
• Get the apron
• Push the button
Get setup trays?
Get supplies for setting up the trays?
How often does someone need to leave the operatory to retrieve something needed for a procedure?
o Do people have to walk any distance to find and communicate with someone when they need them?
o Are there obstacles or obstructions that need to be walked around or avoided?
o How far does front desk personnel have to go to retrieve a file?
o How far does a patient have to walk, and through what procedure to get into the chair and then, out of the office when they leave?
You probably get the idea and are now asking yourself, “Now I’m going to have to knock down walls and rent storage space?!” You don’t have to do everything, but you should have a Lean philosophy always in mind so that you can see any of the one-inch fixes that can be done every hour of every day.
Notice that Oliver Hardy does not like getting into ‘messes’? You should be always on the lookout for ways to avoid or correct the small messes that occur constantly in your office. Remember – at the picnic, it’s not the bears that eat your lunch – it’s the ants! An inch, in this case, is an ant; and it & its friends are eating your lunch every day.
On the overall subject of Lean, I’d like to share with you an experience I recently had. I was in a dental office to make a presentation on our inventory control system. This office realized that they are having a problem controlling the cost of their inventory and had seen how well our system was working in another office.
I made a lunch-time appointment with them for an hour. Lunch was brought in, the presentation was set up and…things started going downhill from there. The doctor and his two assistants sat and started their lunch, the phone rang and they had to answer; and it rang again and they had to answer; and one assistant had to run out of the room, then another, then the doctor. They were running in and out of the room the entire time. (Fine. Thanks for asking, but I’ve been doing this a long time and have the patience of an oyster.) The doctor was answering his cell phone, which rang almost constantly. Mind you, they did have a receptionist working out front. Lunch was eaten standing, sitting, but always on the run.
When we did have a quiet moment, while I was packing up my tent and getting ready to steal away into the sunset, the doctor confided a few things to me. Business was growing almost exponentially, but, he told me that he has young children at home and every day, he is with them and their mother in the morning, drives to work, works a grueling day at his practice, drives home, and is with his family. He bemoaned the fact that the only time he can be just ‘him’ and not functioning as a dentist, husband, or father is during those few precious moments in the car coming and going to work. And, from what I’ve seen, work is no picnic. His weekends are often tied up with work, as well.
So, let’s look at this whole picture for just a minute. I’d suggest the following:
• Keep ‘office hours’. I know a lot of very successful practices that, believe it or not, are closed at chosen times. I’m sure you’ve called an office at say, 12:30 and heard something like this, “Thank you for calling XYZ dental. We are closed from noon to 1:00 each day for lunch. Please call back after 1:00 and we’ll be happy to help you. If you’d prefer, please leave us a message at the tone.” Here’s another one: you call at 5:30 in the evening and you get this, “Thank you for calling XYZ dental. Our office is closed. Our office hours are ……. If this is an emergency, please call xxx-xxx-xxxx. If you’d like, please leave us a message at the tone and we’ll get back with you on our next business day.”
• Do not overbook – you are not an airline and you can’t ‘bump’ your patients.
• Take some time off. Dentistry is an incredibly stressful career. Out of the top 19 occupations that are most likely to suicide, physicians are number two and dentists are number three. (Lubin, 2011)
• Get “Lean”! If your people are running all day long, to the point that they are actually crossing paths dozens of time a day at a quick pace, then it should be evident that something is wrong. Take a 30,000’ view of your office. Imagine what it would look like if you could look down on it from above on a typical work day. What would you see?
Take some time during the day to calm down and breathe. Success is not necessarily equated to activity. There are many definitions of success. Find yours and make sure it’s ultimate goal won’t put you 6’ under. It’s been said, “It’s better to reach for the stars and drag your feet in the clouds than to reach for the clouds and drag your feet thru the trees.”
Buffalo Chips! It’s better to set reasonable, reachable goals and achieve them. Then, build on those successes to achieve greater goals, incrementally. Do you bowl? If you’ve never bowled better than about 150, would it make sense to set a goal that, by this weekend you’ll bowl a perfect score on every game? It’s laughable, right?
Be kind to yourself. Enjoy life. Have a life, for crying out loud!
Next month: Over-processing.
Works Cited
Flinchbaugh, J., & Carlino, A. (2006). The Hitchhiker's Guide to Lean. Dearborn: Society of Manufacturing Engineers.
Lubin, G. (2011, October 18). The 19 Jobs Where You're Most Likel to Kill Yourself. Retrieved May 6, 2014, from businessinsider.com: http://www.businessinsider.com/most-suicidal-occupations-2011-10?op=1#!JCuzI